Editorial: AG Needs To Wake Up, Bust the Medicaid Fraud
But that is still way below average, among the worst in the nation. And with 170,000 New Mexicans poised to join the Medicaid rolls under Obamacare should New Mexico opt in, King needs to get serious about restoring integrity to the system and the bottom line.
And stop giving excuses for why this performance is OK in a state with an estimated $75 million in Medicaid fraud annually.
The national average for Medicaid fraud recovery is $3,700 per $1 million in Medicaid spending; nearly $10 for every $1 spent in fighting fraud. King’s office recovered $988 for every $1 million in
Medicaid spending; $2.74 for every $1 spent in fighting fraud.
When confronted with the disparity, his office provided a letter from the National Association of (state) Medicaid Fraud Control Units to the federal director of Medicaid fraud policy and oversight. Tt says “prosecutorial activity cannot be measured by standardized measurement, review and comparison. Each unit is different and operates differently.”
King is right on one count — his Medicaid Fraud and Elder Abuse Division is very different. According to a Legislative Finance Committee report, it does less with more than those in other states, has a problematic organizational structure, too few special agents, too many open positions, a high rate of outstanding referrals and a backlog of open cases.
King has also said the recovery comparisons don’t take into account his office’s focus on investigating and prosecuting elder abuse, which doesn’t produce a recovery.
But stealing public money intended to pay for seniors’ care — as well as the care of disabled people— is abuse. It’s King’s job to uncover and punish it and protect some of the state’s most vulnerable residents.
And with a potential 170,000 new Medicaid clients in the wings, it’s time for him to start doing that job well.
This editorial first appeared in the Albuquerque Journal. It was written by members of the editorial board and is unsigned as it represents the opinion of the newspaper rather than the writers.
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